SP4.11 - Retrospective review of achalasia management in a tertiary UGI centre

Abstract Introduction Achalasia is a rare disorder significantly impacting quality of life (QoL). Medical management includes calcium channel blockers (CCB), Pneumatic dilatation (PD) and Peroral endoscopic myotomy (POEM). Surgical management includes laparoscopic Heller’s myotomy (HM) or more recently robotic assisted Heller’s Myotomy. Aim This is a retrospective study of management of patients with achalasia in a tertiary Upper GI centre. Material and method Data was collected retrospectively between 2013-2023 (10 years) and analysed using Prism 10. In this period, 193patients with suspected achalasia were analysed and only 89patients with confirmed diagnosis were included. Results Of these 89 patients, 46 were female (48%) and 43 were male (52%). The median age was 61years (range 21-94years). 64 patients (72%) were local referrals and 25 patients (28%) were referred via the network. 3 patients (3%) were acute admissions. 45 patients (50%) received medical therapy initiated by gastroenterologists. 6 patients (6.7%) received CCB, 17 patients (19%) received endoscopic Botox and 22 patients (25%) underwent PD. 6 patients (27%) developed perforation post PD; of these, 3 patients underwent surgical repair and had a prolonged hospital stay. Of the 66 patients (74%) who underwent surgery, 55 patients (61%) had laparoscopic HM, 8 patients (9%) underwent robotic assisted HM and 1 patient (1%) had open HM. Average Length of stay was 5.8 days for laparoscopic HM and 3.9 days for robotic HM. In the laparoscopic HM group 3 patients (5%) had iatrogenic oesophageal injury repaired perioperatively and a further 5 patients (8%) needed oesophageal dilation for residual dysphagia. No complication was noted in the robotic HM group. Conclusion Surgery remains the treatment of choice for achalasia. Early outcomes of robotic surgery look promising, with lesser complication rates thus improving quality of life.